Objective To study the repairation of the appearance and reconstruction of the function to the destructive palm Method Two methods were adopted according to the destructive extent of palm and finger The destructive severed palm can be ectopicaly replanted by four kinds of ways:(1) 2 severed fingers and partial palm were ectopicaly replanted to the end of the forearm (2) 2 or 3 severed fingers and partial palm were replanted to the wrist (3) 5 fingers and partial plam were replanted to the end of the forearm (4)The partial palm was reconstructed and the severed fingers were ectopicaly replanted For the cases suffered from complete or partial destructive palm injury,the corresponding tissues from the foot such as toe,first web,metatarsal bones or dorsal flap were transplanted according to the needs of hand reconstruction Since the blood supply and return system mainly depends on dorsal artery of foot and great saphenous vein,the entire resection and transplantation can be done at one stage in all cases Result All the cases gained success except one finger with partial necrosis Good recovery of appearance and function of hand were obtained Conclusion The destructive palm can be reconstructed by ectopic replantation and tissue transplantation The function and appearance of hand can be improved

BACKGROUND:A selection of treatment for thoracolumbar fracture is very important.OBJECTIVE:To develop and validate three-dimensional finite element models of human thoracolumbar fracture using varying fixation methods,and to compare biomechanical characteristics of fixation method.DESIGN TIME AND SETTING:A contrast observation was performed at the Mechanical Experiment Center of Tongji University from August to October 2008.MATERIALS:64-slice spiral CT (Siemens,Germany) was used to scan T_(11)-L_1 segments of an adult male,and the slice thickness was 0.6 mm.based on Boolean operation,the lower half of T_(12) segment was resected,and the structure of posterior part was reserved to establish finite element model of thoracolumbar fracture.METHODS:There were five groups in this study,including 4 pedicle screws+2 rods (group 1),5 pedicle screws+2 rods at one side (group 2),6 pedicle screws+2 rods at both sides (group 3),anterior fixation (group 4),and anterior plus posterior fixation (group 5).Forces of axial compressive,anterior bending,posterior extension,left bending,and right rotation were loaded to compare the biochemical characteristics.MAIN OUTCOM MEASURES:vonMises stress and displacement at different directions.RESULTS:The stresses of all the fixation screws increased from the anterior part to posterior part in all movement tests,and the strongest stress was measured in the joint position.The stress of proximal screw was stronger than that of the distal screw.Additionally,the stress in group 1 was significantly stronger than in groups 2,3,and 5 (P<0.01).The group 5 was the most stable,but the group 1 was the poorest.CONCLUSION:T_(12) bursting fracture models were established using varying fixation methods,and the results verified that short segment plus fracture vertebral segmental fixation has more superior biomechanics.

Objective:To establish a 3 dimensional finite element model of calcaneus and talus for analysing their stress distribution during different gait phases. Methods: CT scanning and computer image processing system were used to establish the model to simulate the situation of calcaneus and talus for 3 phases (heel strike, midstance, push off) during the gait. A finite element solver was used to calculate stress. Results: A three dimensional finite element model of calcaneus and talus was established. And the stress distribution within the bone was obtained and regions with elevated stress at 3 phases were located. The stress distributions of 3 phases were significantly different. The stress increased gradually from heel strike to push off. Conclusion:The model can be used to study biomechanics of calcaneus and talus. The regions of elevated stress of calcaneus and talus are important, which provide an insight into the factors contributing to the fractures and arthritis.

Objective To study the anatomic relationship between the thoracic transverse process and adjacent bony structures and its clinical significance for thoracic screw fixation.Methods The present anatomic measurement used 45 dry cadaveric specimens of the normal adult thoracic vertebrae.We measured the distances from the horizontal midline of the transverse process to the superior,middle and inferior margius of the pedicle,the height of the anterolateral transverse process sheltered by ribs,and the position at the horizontal midline of the transverse process corresponding to the vertebral body.Results The horizontal midlines margius of the transverse processes of T1 to T10 are localized in the plane ranging from the superior to the inferior margins of the pedicle.The midlines of the transverse process are closer at T6 and T7 while more apart at T9 and T10.From T1 to T8,the anterolateral transverse process is totally or mostly sheltered by ribs,but the shelter is much less at T9 and T10.The horizontal midline of the transverse process corresponds to the upper 1/3 or middle 1/3 of the vertebral body.Conclusion Thoracic screw fixation across the transverse process to the vertebral body is safe,reliable and feasible in clinic.

Objective To introduce our experience of treating Pilon fractures with an articulated and spanning external fixator. Methods From February 2002 to June 2004, 19 patients with high energy Pilon fractures (21 sides) were treated with a T- shaped unilateral articulated and spanning external fixator in our department. The fixators were placed medial1y across the ankle joint, and the fixation of fracture was enhanced by a combined use of limited internal fixation. The main causes of injury were traffic accidents and high altitude falling. The distal 2 pins were inserted into the talus and the tuberosity of calcaneus so that the subtalar joint was treated as an axis during ankle movement. At approximately postoperative 2 or 3 weeks, the articular hinge was released and the patient began ankle exercises. The clinical outcomes and complications were investigated and the postoperative X- ray examinations of the ankle were also evaluated. Results 19 patients were followed up for a mean period of 13 months. No infection of wound or pin site, no neurovascular complication or no nonunion was found. According to Baird & Jackson ankle joint scoring system, their functional evaluation of the ankle scored from 72 to 98 (averaging 92). Clinical results were excellent in 4, good in 12, fair in 3 and poor in 2. Reduction of the articular surface was anatomic in 16, fair in 3 and poor in 2 according to Burwell & Charnley classification. Conclusions External fixation with an articulated and spanning fixator combined with limited internal fixation is a satisfying technique to treat Pilon fractures. This technique can restore anatomical articular surface, allow early ankle joint motion, effectively decrease complications of both wound and bone healing, and prevent ankle joint stiffness after fixation.

Post-traumatic osteomyelitis is painful and challenging disease.High success rate of antimicrobial therapy in most cases has not been achieved in skeleton due to its physiological and anatomical characteristics.The key to successful management is early diagnosis and treatment.Different types of post-traumatic osteomyelitis require different medication and different surgical therapeutic strategies.Post-traumatic osteomyelitis is associated with avascular necrosis of bone and formation of sequestrum(dead bone).Surgical debridement is necessary in addition to antibiotic therapy.Generally,multidisciplinary techniques are required,including orthopaedic surgery,plastic surgery,as well as vascular surgery,especially for complex cases with soft-tissue defect.

From May 1981 to September 1983. experimental study of the effect of buried nerve endings into muscles on the recovery of its motor functions was carried out in our hospital with 40 robust rabbits of both-sexes divided into two groups. In group A. left common peroneal nerve was cut off at the relatively deep site of myoneural junction and divided into three bundles, which were separately buried into long extensor muscle of digits, anterior tibial muscle and long peroneal muscle. For group B. a piece of 1.2cm cut from left common peroneal nerve and another piece of 1.4cm cut from right common per-oneal nerve were freely transplanted to the left-side muscles in the same way as in group A. Experimental results showed that the motor function of the muscles transplanted with nerve ending started to recover in two months after operation, and that the muscle power reached more than the 4th grading and electric irritation could induce muscle contraction at the 6th month after operation. Electromyogra-phic examination showed mixed disturbing potential. The new motor end-plates could be found on his-tological examination. In one clinical case follow-up for 6 months was made post-operatively and the recovering muscle power was fairly satisfactory.

Flap pedicled with the arteria epigastrica superficialis was transposed to primarily repair firearm wound after the rabbit's posterior limb was shotted. Recovery of the wound was observed and the content of bFGF mRNA in myoideum of the concussion area was measured by reverse transcroption polymerase chain reaction(RT PCR). All wounds repaired with transposition of fascia flaps attained primary healing and the content of bFGF mRNA in myoideum of the concussion area was higher than that in the control group. The result suggests that transposition of arterialized fascia flaps could primarily repair firearm wounds successfully and the high expression of bFGF is one of the causes.

Objective Investigate the methods of reconstituting the first web of hand Try to find some ways to make the the lst web more beautiful Method To design a flap including two flap (instep island flap and medial plantar island flap) to reconstitute the lst web of hand the instep flap reconstituted the back of the lst web of hand,the medial plantar flap reconstitute the volaris part of the lst web of hand Result All 9 cases were applied successfully with the transplanted tissue survived The function of hand recovered satisfactorily and the exterior look like original web of hand Conclusion Use combined flap on the medial foot to reconstitute the lst web of hand can recovered either function or original exterior of the lst web of hand

Objective To analyze the stress distribution of calcaneus and talus with posterior facet after compression fracture during gait by finite element method. Methods A wedge was resected to simulate the malunion calcaneus with compression fracture of posterior facet. The Bo?hler’s angle was reduced from 35? to 10?. The calcaneus and talus malunion were used to simulate for three phases of the stance during the gait (heel strike, midstance, push off). A finite element solver to calculate. The results were compared with normal condition. Results The stress distribution within the bone in condition of malunion was obtained, and sites of enhanced stresses for three phases were located. The results were significantly different from that of normal condition. Conclusion The results revealed the importance of reconstruction of calcaneal structure and helped us understand the cause of sequela of calcaneal fractures